Tuesday, April 29, 2008

In July 2005, I wrote the 2nd of my "Challenging Dogma" posts, in which I expose and question certain aspects of the dogma with which I have been indoctrinated in the tobacco control movement. In that post, I explained how groups like Americans for Nonsmokers' Rights (ANR) have convinced anti-smoking advocates nationwide that anyone who disagrees with the agenda of the tobacco control movement is affiliated with the tobacco industry and should be publicly discredited by insinuating that they have a relationship with Big Tobacco.

A letter to the editor in a March issue of The Vital Voice, a St. Louis newspaper, demonstrates the use of this tactic by a national anti-smoking group. The letter responds to a February column written by Bill Hannegan - founder of Keep St. Louis Free (and a regular Rest of the Story reader and commenter) - which argues against bar and restaurant smoking bans, claiming that they will cause economic harm to businesses and that the health effects of secondhand smoke are not severe and can be dealt with adequately using air filtration systems.

In its letter, the anti-smoking group accuses Hannegan of being a paid Big Tobacco "shill." It intimates to readers that Hannegan is simply doing the dirty work for the tobacco industry, taking orders from the public relations department of Philip Morris.

The anti-smoking group writes that it "would like to ask Mr. Hannegan, can you please disclose if you are receiving funds from the tobacco industry or one of its funded organizations? Because the truth of the matter is that tobacco companies have long ago figured out that they can appeal to consumers by painting smoking as a “right” that they should protect at all costs. And they have hired local community activists to do the dirty work for them. ... Considering you think evidence presented by the Surgeon General, the Centers for Disease Control and the American Cancer Society is not valid, we would like to know if you are being paid by the tobacco industry. Because, we might just want to know if our advice on health and freedom is coming from the PR department of Phillip Morris."

The Rest of the Story

I believe it is unethical and inappropriate to publicly insinuate that an individual is a Big Tobacco shill unless you have evidence to support that insinuation. Because the insinuation is made in the form of a question, rather than an explicit statement, the letter falls short of being defamatory; however, the intent of the letter is the same. Even though it is presented in the form of a question, it essentially represents a public insinuation that Hannegan is a Big Tobacco lackey. Many, if not most readers of the Vital Voice are going to come away with the impression that Hannegan is a paid front for Big Tobacco. Even if Bill writes in to deny the accusation, it will be too late. The insinuation alone has already harmed his reputation; moreover, not everyone who read the anti-smoking group's letter is going to read Bill's denial. And why should the burden be on Bill to write a denial in the first place? Should not the burden of proof be on the anti-smoking group to prove, or at least provide evidence for, its insinuation?

In recent days, I myself have been at the receiving end of both explicit and implicit insinuations that I am a paid tobacco shill. The explicit insinuation came from an anti-smoking colleague (who, to his credit, subsequently retracted the accusation and apologized). The implicit insinuation comes from a blog reader, who questions whether I am a Big Tobacco shill, but without providing any evidence to support this insinuation or publicly acknowledging that he has no reason to believe that I am being paid by the tobacco companies to express my opinions.

These examples illustrate the loyal execution of the ANR playbook. If you don't like what someone is saying, cast doubt in the public eye about whether that individual may be associated with Big Tobacco. Whether it is true or not, this will discredit the individual and his or her dissent. Notably, it will also make it more difficult for others to question the anti-smoking agenda in the future; individuals will be reluctant to do so if they are afraid their reputations may be tarnished by these accusations.

Many readers of The Rest of the Story have themselves been subject to this anti-smoking group tactic. I explain here how Dave Kuneman was falsely accused of having worked for Philip Morris (attack courtesy of TobaccoScam); I discuss here how my friend Martha Perske was accused of being a Big Tobacco front (attack courtesy of an article in the American Journal of Public Health); and I discuss here how Michael McFadden was accused of being a tobacco industry lackey (attack courtesy of a past president of the Canadian Thoracic Society).

Monday, April 28, 2008

My third roundtable interview with Gian Turci of FORCES International addresses the widespread misrepresentation of the science of secondhand smoke by anti-smoking groups. The interview includes a discussion of the U.S. Surgeon General's misrepresentation of the acute effects of secondhand smoke, and it debunks the myth that 30 minutes of secondhand smoke exposure is enough to cause heart disease or to precipitate a heart attack in an otherwise healthy nonsmoker.

To my surprise, rather than the 30-minute claims representing a transient bad episode of misrepresentation of science, it is turning out that the 30-minute claims were actually the initial sign of a deteriorating commitment to scientific intergrity and honest communication in the tobacco control movement.

Things have gotten so bad that now a provincial health department can claim that secondhand smoke causes instant cardiac arrest among children and no anti-smoking group goes on the record as rejecting that claim.

What started as an exaggeration of the science has turned into distortion of that science and now into complete fabrication of health effects that do not exist.

Friday, April 25, 2008

In a letter sent in response to a citizen's inquiry about the rationale behind Ontario's proposed ban on smoking in motor vehicles with children present (and presumably being sent to other citizens who write on the same topic), the Ontario Ministry of Health Promotion states that exposure to secondhand smoke increases the risk of cardiac arrest among children.

The letter states: "Clearly, medical science shows that children who breathe second-hand smoke are more likely to suffer Sudden Infant Death Syndrome, asthma, and cardiac arrest."

The Rest of the Story

Let's give the Ministry of Health Promotion a pass on its claim that children exposed to secondhand smoke are at risk of sudden infant death syndrome. Perhaps they were using the term "children" very loosely. Obviously, SIDS is something that occurs to infants and not children. But we'll give the Ministry a pass on that one.

However, there is simply no way to justify or explain the statement that secondhand smoke causes cardiac arrest among exposed children. There is no degree of leniency on the terminology that we can allow that would enable us to interpret that statement as being anything other than blatantly inaccurate.

Children's hearts do not stop beating suddenly because of exposure to secondhand smoke. There is no evidence that secondhand smoke exposure causes acute coronary events of any kind among children. This claim seems to be pulled completely out of the blue. It's not like the claim is even an exaggeration of a claim for which there is evidence. In other words, this is not merely an exaggeration, it is a complete fabrication.

Even worse, the Ministry is claiming not merely that secondhand smoke causes cardiac arrest among children, but that medical science clearly shows that this is the case.

I do not understand why the Ministry of Health Promotion would fabricate such a claim.

First of all, why risk a deterioration of its public credibility? Once found to be fabricating its scientific statements on the health effects of secondhand smoke, would not the Ministry be concerned that its credibility regarding all other health issues be questioned? Is the public going to believe that the Ministry is fabricating medical claims only about one narrow part of a particular health issue, and that everything else it states is completely accurate?

Second of all, why is this fabrication even necessary? If the rationale for banning smoking in cars with children is that the exposure causes health effects, then why aren't the actual documented health effects of secondhand smoke (such as its effects on respiratory infections and asthma) enough? Why must health practitioners fabricate false health effects in order to support this proposed policy?

While I have spent a lot of time criticizing the tobacco companies for fabricating the lack of health effects from smoking and from secondhand smoke, I never thought I would be in a position of having to criticize a public health agency for fabricating the harmful effects of secondhand smoke. And unfortunately, the fact that the intent behind the fabrication is a good one (to protect children's health) does not justify making a false statement to the public. Not only does it undermine the credibility of the public health movement; it also represents a breach of public health's ethical code of conduct.

Once again, I wonder whether I will be one of just a few anti-smoking advocates to criticize the distortion of the science in order to promote tobacco control policy or whether many other anti-smoking advocates and groups will join me in criticizing this fabrication of the science.

Wednesday, April 23, 2008

A new study published in the current issue of the International Journal of Cancer suggests that in contrast to the previous thinking, the health consequences of the use of snus are substantial and that snus-related health risks cannot be lightly ignored (see: Roosaar A, Johansson ALV, Sandborgh-Englund G, Axell T, Nyren O. Cancer and mortality among users and nonusers of snus. International Journal of Cancer, published online April 15, 2008).

Previously, it was thought that snus posed very low health risks and that there was not even a clear association between snus use and oral cancer. The new study, based on a 30-year follow-up of almost 10,000 Swedish men, found "a statistically significant increase in the incidence of the combined category of oral and pharyngeal cancer among daily users of snus (incidence rate ratio 3.1, 95% confidence interval 1.5-6.6). Overall mortality was also slightly increased (hazard ratio 1.10, 95% confidence interval 1.01-1.21)."

The researchers concluded that "Although the combined previous literature on snus and oral cancer weigh toward no association, this population-based prospective study provided suggestive evidence of snus-related risks that cannot be lightly ignored" and that "Even if smoking is without question a much greater threat to health than snus our research rejects the view that the use of Swedish snus is in principle without risk."

The Rest of the Story

Because of the large sample size and long-term follow-up in this study, it carries a lot of weight in terms of evaluating the overall literature on this topic.

This study reports that even though the overall mortality risk associated with the use of snus is not high, there is a three-fold increase in oral and pharyngeal cancer risk among daily snus users. This is a substantial increased risk and the results bring into serious question the previous thinking that snus use is not associated with oral cancer. And because the risks of conventional smokeless tobacco are much greater than those of snus, the oral cancer risk from such products are likely to be even higher than observed in these snus users.

These results are important because they question the thinking that smokeless tobacco (or snus in particular) should be promoted as an alternative to smoking cigarettes. They also bring into question the statement that smokeless tobacco is a safer alternative to smoking. While it may be safer in terms of overall mortality, it does not appear to be safer in terms of oral cancer risk. Thus, the unqualified statement that smokeless tobacco is safer than smoking does not appear to be warranted.

This study also highlights the point I made in an earlier post in which I criticized a former oncologist who took on a leadership position at Swedish Match for having the gall to tell the public that he was now working to promote the public's health. The rest of the story is that he is, in fact, promoting oral cancer among his customers. That is hardly what I would call promoting the public's health. In fact, he has switched from fighting cancer to helping promote it. And despite the fact that he can rightly claim that the overall mortality from snus use is much lower than that from smoking cigarettes, he has no business claiming that he is now in the business of promoting the public's health. Sellers of cancer-causing products are not in the business of health promotion. And we need to keep that straight.

Monday, April 21, 2008

Action on Smoking and Health (ASH) has suggested that individuals who smoke in the presence of others should possibly be charged with criminal homicide if the exposed individuals die from a secondhand-smoke related lung cancer or heart attack.

In a press release issued last week, ASH writes: "As the evidence that secondhand tobacco smoke kills tens of thousands of Americans each year multiplies, the potential for civil - and possibly even criminal - liability for subjecting other people to it grows, says public interest law professor John Banzhaf, Executive Director of Action on Smoking and Health (ASH), America's first antismoking organization."

"He notes that criminal liability has been imposed upon people who, knowing that they have the AIDS virus, nevertheless expose others to it by having sexual intercourse with them, even though the risk that their sexual partner will actually come down with AIDS as the result of such exposure is quite small." ...

"At some point, deliberately and repeatedly subjecting another person to a substance the federal government has ruled to be the most deadly carcinogen to which we are exposed moves beyond mere negligence (the mere lack of sufficient care) and battery (which requires an intent to cause harm) to a depraved indifference to the consequences (the requirement for criminal homicide), says Banzhaf."

"Banzhaf notes, however, that the first criminal prosecutions for a homicide caused by exposure to tobacco smoke are more likely to occur when the smoke triggers a fatal heart attack - which the Centers for Disease Control says can occur within thirty minutes, compared with years for smoke to cause death by fatal lung cancer."

The Rest of the Story

I'm sorry to break the news to ASH but there is no way that exposing others to secondhand smoke could possibly reach the level of criminal homicide except in the highly hypothetical, drastic, and extremely unusual situation that a person continually forced another person to breathe secondhand smoke with full knowledge that the smoke exposure would likely cause that person to die.

One could imagine a highly hypothetical and extreme case where a smoker knew that another individual had asthma which was likely to be exacerbated into a fatal asthma attack by exposure to secondhand smoke and the smoker forced that person to inhale secondhand smoke. A criminal homicide charge could potentially be considered in this extreme situation.

However, outside of that, ASH is completely off base. The reason: because there simply is no negligence.

How can you argue that a reasonably prudent person acting under similar circumstances would not have exposed anyone else to secondhand smoke when it is common practice for smokers to smoke in the presence of other people and it is lawful for smokers to do so?

The risk of a person dying from being exposed to secondhand smoke is exceedingly small. Thus, a reasonable person would not necessarily surmise that his or her tobacco smoke was going to cause death to the exposed individual.

While it could be successfully argued that the reasonable person is aware that secondhand smoke can be harmful to others, I cannot imagine a successful argument that the reasonable person would be aware that exposing a person to secondhand smoke is likely to kill that person.

In order to meet the threshold for involuntary manslaughter (the only criminal homicide charge that could even be considered), it would have to be shown that the smoker exercised not only an unreasonable but also a high degree of risk. There is certainly not a high degree of risk of death inherent in exposing another person to secondhand smoke (with the only exception being the extreme case of a severe asthmatic known to have life-threatening attacks induced by tobacco smoke exposure).

An equally large and dismissive barrier to criminal homicide in secondhand smoke cases is the assumption of risk by those who are being exposed to secondhand smoke. If the exposed individual has consented to the exposure, then there is no liability even if there is negligence. Unless the smoker is forcing the nonsmoker to be exposed, there will be no personal liability.

Since there is no valid legal basis for what ASH is suggesting (and not even a remotely valid one), I can only surmise that there is some other purpose behind this initiative. My guess? It appears to me that ASH just hates smokers and really wants to rub their faces in the dirt as much as it can.

Wednesday, April 16, 2008

Once again, I have been publicly accused by a fellow anti-smoking advocate colleague of being a paid lackey for Big Tobacco.

On a Facebook smoke-free advocacy site, an anti-smoking advocate told readers that I am well known to be a tobacco industry mole who is paid large sums of money by the tobacco money to present reports to help the industry.

The advocate wrote:

"Dr Siegel who used to be a prominent researcher for tobacco control has been and is very well know in political circles that deal with this issue paid very healthy sums of money by the tobacco manufactures to present reports that are favourable to help the multi billion $$ industry seem OK."

A reader then asked:

"Can you please provide some evidence on Dr. Siegel."

The advocate responded:

"You seem to be good at Googling info on why smoking is good...look for the info on the Doc...it's out there."

Fortunately, when I confronted the advocate and asked him to present the evidence that I am indeed a Big Tobacco-paid lackey, he then retracted the claim and apologized to me:

"I would like to retract my comments made regarding Michael Siegel."

The Rest of the Story

While I do not harbor any ill will towards the advocate who made this accusation and I appreciate his retraction, I think it is important to write about this episode because it illustrates a number of very important general points.

First, it demonstrates the extent of the campaign out there among my colleagues to discredit me by defaming my character. This particular exchange took place on a Facebook site dedicated to promoting a smoke-free restaurant law in Gibraltar, of all places.

I am not blaming this advocate in Gibraltar because he most likely got the "information" about me from the Globalink list-serve. Thanks to the defamatory comments made about me on this international tobacco control list-serve, my reputation internationally as a Big Tobacco lackey has now been solidified.

Interestingly, while I was thrown off the Globalink list-serve for expressing some dissenting opinions, the advocates who made defamatory comments about me on that site were not disciplined in any way.

This is precisely the way in which the anti-smoking movement ensures that it presents a monolithic presence to the public. It is able to quell dissent because people know that if they air dissenting opinions, their careers in tobacco control will be ruined as they face personal attacks like those I am highlighting here.

Second, this story highlights the black and white, all or nothing thinking that pervades the current tobacco control movement. You either have to be a full believer or you are not a believer at all. If you don't accept 100% of the established dogma, then you might as well not accept any of it, for you are no longer considered part of the movement.

Now what I need to do is figure out where I misplaced all that money I have received from Big Tobacco.

Tuesday, April 15, 2008

Responding to an article which reported that one in four heart transplant patients resume smoking after their operations, Action on Smoking and Health (ASH) has suggested that former smokers should be made ineligible for heart transplants.

In its press release, ASH wrote: "More than one in four heart transplant patients start smoking again after their operation, a move which slices their life expectancy, and is being called a 'disgrace' and 'selfish,' considering that half of those who need a heart replacement die while awaiting a donated transplant. Indeed, since many families of heart donors are 'very upset and disappointed' when former smoker donors 'waste' this gift of life by smoking again, perhaps they should begin to specify that hearts should go only to those who never smoked, or who gave it up many years ago, says Action on Smoking and Health (ASH)."

The Rest of the Story

This is an extremely dangerous position for an anti-smoking group to take. It is dangerous because it crosses the line into making medical treatments contingent upon an individual having a lifestyle that is acceptable to the family of the organ donor, or to certain medical authorities. The same reasoning could be used to deny heart transplants, or other medical procedures, to people of certain racial/ethnic or religious groups.

In other words, this position represents one of discrimination and bigotry. It needs to be condemned immediately by other anti-smoking groups throughout the country.

ASH actually puts forward the argument that denying heart transplants to former smokers is not analogous to denying the procedure to people of a certain race or religion: "Conditioning the gift of a heart upon a requirement that it not be largely wasted by being transplanted into someone very highly likely to smoke and risk a condition called graft coronary artery disease, where blood vessels connected to the new heart are damaged by the toxic chemicals in tobacco, is very different from trying to prevent a heart from being donated to someone because of his or her race, religion, or similar immutable characteristics, Banzhaf suggests."

However, this argument falls apart because being a former smoker is, in fact, an immutable characteristic. Once you have smoked, you are always a former smoker. There is no way to become a neversmoker once you have smoked. Thus, it is an immutable characteristic and denying a transplant from such a person is analogous to denying a transplant to a person on the basis of race, religion, or other immutable characteristics.

Just because ASH seems to despise smokers and former smokers is no valid reason to categorically deny heart transplants to every person who has ever smoked. Importantly, this is not a medical criterion. It is a personal value judgment.

To be a valid medical criterion, one would have to judge each individual separately based on his or her own personal situation. That's how medicine is practiced. We do not make assumptions about an individual's personal suitability for a procedure based solely on the category to which that person happens to belong.

Doing so, and following ASH's advice here, would lead to blatant and unacceptable discrimination.

For example, suppose that data showed that people who are poorer and less educated are more likely to resume smoking after a heart transplant. Using ASH's reasoning, we should deny heart transplants to people who are poor or uneducated. This would lead to a discriminatory system of transplantation, where only the upper socioeconomic classes would be eligible for these procedures. Transplants would be unavailable for the lower socioeconomic classes.

This is why in medicine we do not make assumptions about patients based solely on the groups to which they belong. We don't deny procedures to patients based on group membership unless that group membership automatically affects the medical appropriateness of the procedure.

What ASH is suggesting here would not only result in bigotry and discrimination in organ transplantation, it would also destroy the very heart and soul of medicine: the principle that individuals should be treated as individuals and that decisions should be made based on the best interest of that particular patient, not based on any group to which the patient belongs (unless that group membership directly affects the medical appropriateness of the treatment).

I have seen the effects of treating people categorically, and it is quite unfortunate. For example, I observed that physicians often assume that people who are poorer or people who are of color are more likely to abuse pain medication. Perhaps there is even some data out there supporting such an impression. However, the result of categorically denying adequate pain medication to people of color is a medical system in which these people are disproportionately suffering pain. It is discrimination and racism. And it is based on the very same thinking that ASH asks us to bring to the issue of eligibility for organ transplantation.

There is no place for discrimination and bigotry in the practice of medicine. And I hope other anti-smoking groups join me in speaking out against the position that ASH has advanced here.

Monday, April 14, 2008

Last month, Berkeley approved an ordinance that prohibits smoking on all sidewalks in commercial areas of the city, resulting in a nearly complete outdoor smoking ban in these large areas (see my original post on this ordinance, in which I argue that the measure is largely designed to get homeless people off the streets to make them more attractive for shoppers in the city's business districts). According to an article on the InsideBayArea.com web site, Berkeley City Councillors approved this measure despite concerns that it might lead to increased secondhand smoke exposure among children, whose parents may smoke inside rather than face fines for smoking outside on the sidewalk.

According to the article: "The City Council unanimously passed the ordinance, which goes into effect in May, at its Tuesday night meeting. The ordinance carries fines of up to $100 for a first offense and $500 for a third offense in one year, said Lauren Lempert, senior management analyst for the city. ... Lempert said the officials originally decided not to ban smoking on all commercial sidewalks, because it conflicted with a health department campaign urging people to smoke outside, rather than inside, where others are affected by secondhand smoke. In the end, the city decided that it won't hurt those people who go outside to smoke to walk a few extra blocks to a noncommercial area. 'We felt (the new ordinance) is more supportive of public health goals of the city overall,' Lempert said. 'You have to balance all kinds of needs and interests.' About 10 percent of Berkeley's population, or 11,000 people, smoke, according to the city of Berkeley Health Status Report. City officials hope the new law cuts that number. 'It is known that by expanding restrictions, it reduces the number of people who smoke,' Lempert said."

The Rest of the Story

This appears to be an example of mixed up priorities. The policy makers here appear to acknowledge that the ordinance will likely increase secondhand smoke exposure for children: that is in fact the reason why they did not pass such a policy earlier. However, they are so determined to get homeless people off the streets in front of these stores that the health of the children comes second.

I have long argued that one of the adverse consequences of widespread outdoor smoking bans like this one is that they will result in smokers choosing to smoke inside, rather than face fines for smoking outdoors. For those smokers who have or live with children, this will result in increased secondhand smoke exposure for these kids. What we want, in fact, is for smokers who live with children to smoke outdoors, so as not to expose those children. Banning outdoor smoking virtually everywhere in large areas of a city is the last thing in the world that we want to do if we are concerned about the health of children.

What is telling is that the city officials appear to acknowledge that this is going to be a problem. They apparently decided to expand the ordinance to cover all sidewalks in all commercial areas because they wanted "to add southern and western Berkeley where a higher proportion of black adults live, who are 1.6 times more likely to smoke than white adults, according to a city of Berkeley Health Status Report. Children under age 5 have a higher rate of asthma in southern and western Berkeley, one consequence of inhaling secondhand smoke, according to the city."

These are precisely the areas of the city where you do not want to send parents the message: "Don't go outdoors to smoke." You absolutely want them to smoke outdoors.

Not surprisingly, it appears that getting the homeless off the streets will come at the expense of the city's black children, who will likely face even higher risks of asthma due to their parents choosing to avoid fines by smoking indoors rather than out.

The argument that this ordinance supports broader public health goals by deterring people from smoking does not hold water. There is no evidence that outdoor smoking bans such as this one results in increased rates of smoking cessation. What does appear to happen is that people change where they smoke, not whether they smoke.

But that's precisely the problem. By pushing smokers from outdoors (where they will not expose their children) to inside (where they may expose children), we are actually harming the public's health, not improving it.

But at least Berkeley business owners won't have to contend with the homeless people outside their doors.

Friday, April 11, 2008

My second interview with Gian Turci of FORCES International was posted online today. It focuses on two issues.

First, we discuss the increasing worldwide trend of employment discrimination against smokers. Increasingly, companies are implementing policies of refusing to hire smokers (or even to fire existing employees who smoke). We also cover the issue of doctors or hospitals refusing to treat smokers, even when that treatment is medically indicated.

Second, we discuss the groupthink mentality in the tobacco control movement and the resulting inability of the movement to tolerate any dissent. I share personal experiences with the suppression of dissenting opinions, attacks against those who do choose to express their dissent, and the censorship of dissenting opinions within the movement.

I hope The Rest of the Story readers will enjoy listening to this interview.

Wednesday, April 09, 2008

Even after being publicly scolded by the New England Journal of Medicine for her failure to disclose the tobacco industry funding of her research on the use of CT scans in lung cancer screening and her significant financial interest in a manufacturer of CT scanners, the researcher from Weill Cornell Medical College and the school itself have again defended her failure to provide these disclosures.

In a statement released by Weill Cornell Medical College on April 4, the school not only defended the researcher in failing to disclose significant financial conflicts of interest to medical journals, but it also blamed the New York Times for inaccurate reporting.

According to the statement: "As you may know, an article appeared last week in The New York Times (Mar. 26, 2008) alleging that two Weill Cornell Medical College (WCMC) researchers did not fully disclose that their research on the use of CT screening for the early detection of lung cancer was partially funded by money from a tobacco company, and did not properly disclose the existence of the Foundation that received the funds. We believe the article did not present a complete picture of the facts and that its primary conclusion -- that Weill Cornell intentionally attempted to conceal the gift in the Foundation -- is simply wrong."

The statement then goes on to argue that Liggett's gift to the Foundation which funded the research was widely publicized at the time the donation was made. It also argues that the failure to disclose the tobacco industry funding was not intentional.

In terms of the failure to disclose the researcher's financial interest in the use of CT scans for lung cancer detection (she apparently receives royalties from General Electric after the licensing of the patents to GE), Weill Cornell Medical College defends the disclosure failure on the grounds that "Henschke and Yankelevitz did not use the GE products developed under the licensing agreement as part of the I-ELCAP, and did not require participating I-ELCAP institutions to use the GE product."

The statement also contends that the researcher published a public apology in the New England Journal of Medicine. According to the statement: "Some of those publications have disagreed with Dr. Henschke and Dr. Yankelevitz's judgment on these, and corrections and apologies have been published in those journals."

The Rest of the Story

I find this to be a truly pathetic attempt to defend what was clearly an inappropriate failure to disclose two important conflicts of interest.

First, the funding by the tobacco industry needs to be disclosed in the article itself, and to the journal. It is not enough to expect that the journal editors will look up the Foundation for Lung Cancer on the internet and search newspaper articles to try to find out who the Foundation's donors are.

I do not believe that Dr. Henschke can hide behind the excuse that she disclosed funding from the Foundation for Lung Cancer: Early Detection, Prevention & Treatment, and so that she did indeed disclose her funding sources. The intent of disclosure of funding is to provide editors, reviewers, and the public with relevant information about the source of funding, not merely to provide the name of the foundations or entities set up to receive that funding. Thus, I view the failure to disclose her funding from Liggett as a significant violation of ethical standards of conduct.

This defense is inadequate and it is unfortunate that the researcher is not willing to take responsibility for this failure. In many ways, I find this defense to be a worse offense than the original disclosure failure. To make a mistake is human, and perfectly acceptable if you admit your mistake, apologize, and learn from it. But to deny that there was any mistake and to worm around, trying to convince the public that you have indeed disclosed the funding when you haven't, makes the original offense even worse.

Second, whether Dr. Henschke used GE products in her research or not is immaterial to the question of whether her financial interest in General Electric represents a conflict of interest. It is not a conflict of interest because she is using GE products; it is a conflict of interest because she has a financial interest in a company which stands to gain financially from the widespread use of CT scanning for early detection of lung cancer. Thus, there would be a significant financial conflict of interest even if this research employed only CT scanners made by other manufacturers.

Again, this attempt to confuse the public and obscure the underlying issue is quite unfortunately. And again, I find this aspect of the defense to be worse than the original failure in disclosure.

To make matters even worse, it appears that the statement is dishonest in asserting that an apology was published in the New England Journal of Medicine.

Two corrections were published. In the first, the author writes: "In our article published in the October 26, 2006, issue of the Journal, one of the disclosed sources of funding was the Foundation for Lung Cancer: Early Detection, Prevention and Treatment, which provided partial support for our research. For full transparency we wish to inform you that $3.6 million (virtually all of the Foundation's funding) was contributed in 2000 through 2003 as an unrestricted gift by the Vector Group, the parent company of Liggett Tobacco, which manufactures cigarettes."

No apology is offered, nor is any wrongdoing admitted.

In the second correction, the Journal writes: "The disclosure statement (page 1769) should have read as follows: 'Drs. Henschke and Yankelevitz report receiving royalties from Cornell Research Foundation as inventors of methods to assess tumor growth and regression on imaging tests for which pending patents are held by Cornell Research Foundation and licensed to General Electric. No other potential conflict of interest relevant to this article was reported.'"

Again, no apology is offered here.

So unless I am missing something, it appears that the Weill Cornell Medical College statement is dishonest. There is no apology that I can find in the New England Journal of Medicine for these two failures in disclosure.

I would have a lot more respect for the Weill Cornell Medical College and the involved researchers if they simply admitted that a mistake was made and apologized for it. That would be the end of the story. We all make mistakes and we can learn from them.

However, instead of admitting a mistake and apologizing, the researcher's and the school's response has instead been to deny wrongdoing, obscure the issues, hide behind immaterial points that will confuse the public, and to go so far as to attack the New York Times for its reporting of the issue.

So let's now get to that important issue. Cornell is attacking the New York Times for falsely implying that the failure to disclose the tobacco industry funding of the research was intentional. Well, if it wasn't intentional, then Cornell must be claiming that there was simply a mistake. The investigator intended to disclose the tobacco funding, but somehow forgot to do so.

Unfortunately, that is clearly not the case in this situation (at least, it's not what Cornell states is the situation). Cornell is not advancing a position that Dr. Henschke revealed the tobacco funding of the research to the Journal, but the Journal just forgot to publish it. Nor is Cornell suggesting that Dr. Henschke intended to disclose the tobacco funding but simply forgot or neglected to include it in her manuscript.

It seems quite clear that the failure to disclose the tobacco industry funding was indeed an intentional failure. There was no intent upon the part of Dr. Henschke to inform the New England Journal of Medicine and the readers of the article that this work was funded by a grant from Liggett.

Had the intent been to make readers aware of the tobacco funding, then Dr. Henschke would have revealed that funding.

So I believe that the New York Times was in fact entirely correct in asserting that the failure to disclose the tobacco funding was intentional.

In closing, I have to say that the original failures to disclose the tobacco funding and the royalties from the patents licensed to General Electric pale in comparison to Weill Cornell Medical College's attempt to defend, obscure, and apparently - to lie - about aspects of the issue at hand.

If they simply came out and said: "We made a mistake. We're sorry," that would be the end of the story and I would have great respect for them.

Tuesday, April 08, 2008

In a news segment on CNBC yesterday, the station featured a debate on the FDA tobacco legislation between Jacob Sullum, senior editor at Reason Magazine (who opposes the legislation), and Dick Woodruff, senior director of the American Cancer Society's Cancer Action Network (who supports the legislation).

I urge readers to listen to this segment, because I find it very revealing. Beyond the fact that Woodruff was quite rude (interrupting Sullum on the first question, which was directed to Sullum, and answering the question himself - Sullum waited patiently and courteously until Woodruff was finished and he was called on), the most telling thing to me was the fact that the American Cancer Society representative offered no substance to support his position, while Sullum offered several compelling substantive points which were not addressed by his opponent.

The only point which the American Cancer Society seemed capable of making was that this is "very important legislation" that will help the kids. Woodruff repeated this argument over and over, but offered no argument or explanation of why this legislation is important or how it will protect kids. He asserted that the legislation will stop tobacco industry marketing to youths, but offered no explanation for how that would occur. He asserted that the legislation would curtail youths' addiction to cigarettes, but offered no explanation for how that would occur. In sum, he presented no evidence to back up any of his assertions about the legislation. It was support without substance.

In contrast, Sullum made several very specific arguments, backed by evidence, to argue that the legislation would actually be harmful to the protection of consumers.

First, the legislation would harm consumers by allowing the FDA to reduce (but not eliminate) nicotine levels. Research shows that this would result in people smoking more, and thus being exposed to higher doses of toxic and carcinogenic tar. The result would be increased disease and death among smokers.

Second, the legislation would harm consumers by making it impossible for safer cigarettes to enter the market. The legislation places insurmountable obstacles to the introduction and approval of safer cigarettes. It essentially freezes the current market, ensuring that competition from smaller companies which might seek to market safer cigarettes is stifled. In addition to protecting the leading company - Philip Morris - from competition, the legislation essentially ensures that the current mix of cigarettes on the market will be sustained in perpetuity. The legislation stifles what might otherwise be a free market competition to produce a truly reduced risk cigarette.

Third, the legislation would harm consumers by interfering with the accurate communication of relative risks of various tobacco products. For example, companies could not state that smokeless tobacco is a less hazardous alternative to smoking cigarettes, even if they could support that statement with extensive documentation.

Interestingly, Woodruff failed to respond substantively to any of these points. He merely reiterated his rhetoric about how this is important legislation that will protect kids.

What is so frustrating to me about this interview is that it seems the anti-smoking movement is no longer able to respond substantively to its critics. It is no longer able to provide a science-based, evidence-based argument in support of a federal tobacco control policy it favors. It has become a purely political movement, advancing political rhetoric that is devoid of scientific, rational, or evidential substance.

Monday, April 07, 2008

The St. Louis University Tobacco Prevention Center had the audacity to claim that Plutonium 210 - which does not exist anywhere in the known universe - is present in secondhand smoke. This claim was made in correction of an earlier claim that secondhand smoke contains asbestos. For this, the St. Louis University Tobacco Prevention Center is today being crowned the winner of the Most Ridiculous Secondhand Smoke Health Claim Tournament.

The winning claim is: "Arsenic, benzene, carbon monoxide, Plutonium 210 and a host of other poisons are in secondhand smoke."

It takes persistence and determination to win tournaments and the St. Louis University Tobacco Prevention Center certainly seemed determined to make a claim that would knock the socks off of the public. First, it claimed that secondhand smoke contains asbestos. Then, when that claim was debunked, it retracted the asbestos but instead, stated that secondhand smoke contains plutonium.

To the best of my knowledge, there was no further retraction of the plutonium claim. Apparently, the St. Louis University Tobacco Prevention Center stands by its claim that secondhand smoke contains plutonium.

Second place in the tournament goes to another Missouri group - Smokefree Air for Everyone - which claimed that just 20 seconds of secondhand smoke exposure can cause a stroke in an otherwise healthy person.

A critical reason why these organizations did so well in the tournament is that they did not retract these absurd claims. You don't get rewarded for simply making a mistake. Anyone can make a mistake. What you are rewarded for here is making the mistake but failing to correct it. This is especially impressive because both of the web pages with these fallacious claims are still active and accessible, and thus the public is still reading this inaccurate information.

As a public health practitioner, I believe that there is a responsibility of tobacco control groups to accurately communicate science to the public. I also believe it is unnecessary to exaggerate or distort the truth because the known chronic effects of secondhand smoke should be enough. But if tobacco control groups continue to misrepresent the science, the credibility of the anti-smoking movement will be threatened. My hope, through this tournament, is to restore the tobacco control movement by highlighting the questionable tactics being used, holding the organizations accountable to the public, and putting pressure on the relevant organizations to correct their actions.

If all goes well, there will not be a need for a 2009 Tournament. However, based on the response I have received thus far from anti-smoking groups whose claims I have questioned, there is no reason to believe that things will go well. Instead of responding substantively and defending or correcting the claims, most of the groups have instead attacked me.

Somehow, I have a feeling that there will be plenty of entries for the 2009 Tournament.

Sunday, April 06, 2008

Memphis and Kansas are not the only tournament finalists from yesterday's Final Four action. Today, we also learn the winners of Final Four action from the Most Ridiculous Secondhand Smoke Health Claim tournament.

According to theSt. Louis University Tobacco Prevention Center: "Arsenic, benzene, carbon monoxide, Plutonium 210 and a host of other poisons are in secondhand smoke."According to theAmerican Cancer Society: "Immediate effects of secondhand smoke include cardiovascular problems such as damage to cell walls in the circulatory system, thickening of the blood and arteries, and arteriosclerosis (hardening of the arteries) or heart disease, increasing the chance of heart attack or stroke."

The Winner: St. Louis University Tobacco Prevention CenterAccording to the Tobacco Prevention Center, not only is secondhand smoke poisonous, but it also can be used as a nuclear weapon. If you want to find weapons of mass destruction, I guess you need not go any further than your corner bar. But what makes the St. Louis University Tobacco Prevention Center claim the hands-down winner is that it came in the context of correcting an earlier statement that secondhand smoke contains asbestos. You would think that having been caught with an egregious error like that, you would be extremely careful in fixing it. But instead, you come up with a claim that it exceedingly more ridiculous than the original fallacious claim. That gets you a place in the finals, for sure.

The Winner: Smokefree Air for EveryoneAlthough it was difficult to watch Breathe California of Sacramento-Emigrant Trails go down to defeat, there really is something to be said for an organization that is willing to claim that a mere 20 minutes of secondhand smoke exposure can cause an otherwise healthy person to suffer a stroke. You also have to appreciate the gutsiness of this organization going beyond the 30 minute claims and cutting down the time required for a healthy person to suffer a fatal event to only 20 minutes.

So I'm happy to announce that we will have an all-Missouri final (we can call it the I-70 series, revisited:

St. Louis University Tobacco Prevention Center (St. Louis, MO)"Arsenic, benzene, carbon monoxide, Plutonium 210 and a host of other poisons are in secondhand smoke."

Friday, April 04, 2008

Here are the winners of the first and second rounds of the Most Ridiculous Secondhand Smoke Health Claim tournament:

EAST REGION

CONTEST 1

United States Surgeon General's Office (Washington, DC)

vs.Action on Smoking and Health (Washington, DC)

According to theUnited States Surgeon General's Office: "Even brief exposure to secondhand smoke has immediate adverse effects on the cardiovascular system and increases risk for heart disease and lung cancer."

According toAction on Smoking and Health: "Even for people without such respiratory conditions, breathing drifting tobacco smoke for even brief periods can be deadly. For example, the Centers for Disease Controls [CDC] has warned that breathing drifting tobacco smoke for as little as 30 minutes (less than the time one might be exposed outdoors on a beach, sitting on a park bench, listening to a concert in a park, etc.) can raise a nonsmoker'’s risk of suffering a fatal heart attack to that of a smoker."

The Winner: Action on Smoking and HealthWhile the Surgeon General has the audacity to claim that brief exposure to secondhand smoke increases the risk for heart disease, Action on Smoking and Health has the bold audacity to actually quantify that increased risk, claiming that it brings the risk of a fatal heart attack up to the same level as that of an active smoker.

CONTEST 2

Smoke Free Gwinnett Coalition (Lawrenceville, GA)

vs.St. Louis University Tobacco Prevention Center (St. Louis, MO)

According toSmoke Free Gwinnett: "Nonsmokers exposed to secondhand smoke for just 30 minutes experience hardening of the arteries."

According to theSt. Louis University Tobacco Prevention Center: "Arsenic, benzene, carbon monoxide, Plutonium 210 and a host of other poisons are in secondhand smoke."The Winner: St. Louis University Tobacco Prevention CenterIt's hard to compete with plutonium in secondhand smoke. This one was a blow-out victory.

East Regional Final:Action on Smoking and Health vs. St. Louis University Tobacco Prevention CenterThe Winner: St. Louis University Tobacco Prevention Center

SOUTHREGION

CONTEST 1

American Cancer Society (Atlanta, GA)

vs.Louisiana Public Health Institute (New Orleans, LA)

According to theAmerican Cancer Society: "Immediate effects of secondhand smoke include cardiovascular problems such as damage to cell walls in the circulatory system, thickening of the blood and arteries, and arteriosclerosis (hardening of the arteries) or heart disease, increasing the chance of heart attack or stroke."

According to theLouisiana Public Health Institute: "Comparing the effects of active smoking and secondhand smoke, researchers found that chronic exposure to secondhand smoke is about 80% as harmful as smoking a pack of cigarettes per day."The Winner: American Cancer SocietyAlthough the Louisiana Public Health Institute put up a good fight, the claim that secondhand smoke can immediately cause hardening of the arteries is just too hard to beat.CONTEST 2

Coalition for a Healthy and Responsible Tennessee (Nashville, TN)

vs.Audubon Area Community Services, Inc. (Owensboro, KY)

According to theCoalition for a Healthy and Responsible Tennessee: "The Journal of the American Medical Association reports that just 30 minutes of exposure to secondhand smoke changes blood chemistry and increases the risk of heart disease in non-smokers."

According toAudubon Area Community Services, Inc.: "As little as 30 minutes of secondhand smoke can lead to hardening of the arteries in nonsmokers, Japanese researchers reported at an American Heart Association (AHA) meeting in November."The Winner: Audubon Area Community Services, Inc.Thirty minutes of tobacco smoke causing hardening of the arteries easily beats the same 30 minutes merely increasing the risk of developing hardening of the arteries.South Regional Final:American Cancer Society vs. Audubon Area Community Services, Inc.The Winner: American Cancer Society

MIDWEST REGION

CONTEST 1

Smokefree Air for Everyone (Columbia, MO)

vs.Indiana University (Bloomington, IN)

According toSmokefree Air for Everyone: "After 20 minutes, blood platelets look like a pack-a-day smoker's, making your blood "sticky" and contributing to stroke causing blood clots."

According toIndiana University: "Exposure to second-hand smoke for just 30 minutes can rapidly increase a person's risk for heart attack, even if they have no risk factors. The smoke, which contains carbon monoxide, causes blood vessels to constrict and reduces the amount of oxygen that can be transported in the blood."

The Winner: Smokefree Air for EveryoneA close contest, but 20 minutes of exposure causing a stroke just beats out 30 minutes causing a heart attack.

According toAmericans for Nonsmokers' Rights: "Just thirty minutes of exposure to secondhand smoke can cause heart damage similar to that of habitual smokers. Nonsmokers' heart arteries showed a reduced ability to dilate, diminishing the ability of the heart to get life-giving blood."The Winner: Breathe California of Sacramento-Emigrant TrailsAs hard as it is to see my alma mater (ANR) go down to defeat, Breathe California of Sacramento-Emigrant Trails earns the victory, not only for its outlandish statement, but for having the audacity to tell us that it cannot change the error because its web master is away (for 5 months now).

CONTEST 2

Tobacco Free Coalitions of Clark County and Skamania County (Stevenson and Vancouver, WA)

According to theCity of Laredo, Texas: "After 120 minutes of breathing secondhand smoke, the risk of an irregular heartbeat (arrhythmia) that can itself be fatal or trigger a heart attack increases."

The Winner: City of Laredo, TexasWhile the 30 minutes of tobacco smoke leading to hardening of the arteries claim is old hat and has been made by many contestants, the 120 minutes of tobacco smoke leading to fatal cardiac arrhythmias claim is more original. And it is just as absurd. There is absolutely no evidence for either of these claims. So a close contest, but Laredo pulls it out at the buzzer.

Voting for the national semifinals is now on. The finalists will be announced on Sunday and the national champion will be announced on Monday (the same day that the NCAA basketball champion will be crowned).

According to theSt. Louis University Tobacco Prevention Center: "Arsenic, benzene, carbon monoxide, Plutonium 210 and a host of other poisons are in secondhand smoke."According to theAmerican Cancer Society: "Immediate effects of secondhand smoke include cardiovascular problems such as damage to cell walls in the circulatory system, thickening of the blood and arteries, and arteriosclerosis (hardening of the arteries) or heart disease, increasing the chance of heart attack or stroke."

According toSmokefree Air for Everyone: "After 20 minutes, blood platelets look like a pack-a-day smoker's, making your blood "sticky" and contributing to stroke causing blood clots."

Thursday, April 03, 2008

In an article published in the current issue of Tobacco Control, The World Health Organization's Study Group on Tobacco Product Regulation (TobReg) is promoting the regulation of cigarettes by mandating that all cigarettes be altered (or removed from the market) so that they meet the median level (in all cigarettes) of 9 specific toxicants, measured in terms of the amount of the constituent measured per milligram of nicotine.

The recommendation calls for "establishing levels for selected toxicants per mg nicotine and prohibiting the sale or import of cigarette brands that have yields above these levels." The recommendation specifies nine toxicants that would be regulated. "The initial levels suggested for regulating [2 of the toxicants] are the median values for the brands on the market, and for seven additional toxicants the levels recommended are set at 125% of the median value of the toxicant per mg nicotine for the brands on the market being regulated."

According to the article: "Prohibiting consumer communications based on any machine measurements is a necessary condition of this strategy. Given the limitations of existing science, regulatory authorities have an obligation to ensure that the public is not misled by the results of the recommended machine testing and mandated lowering regulatory strategy, as the public was misled by the use of machine testing for tar and nicotine yields."

The Rest of the Story

While at first glance, this might appear to be a rational approach (although I'm not sure why it would), the authors of the article readily acknowledge the following:

1. At the present time, no measures -- including the measure of the level of these nine toxicants per mg nicotine -- have "been validated as reliable independent predictors of differences in tobacco related disease risk among smokers using different products."

2. "It is generally assumed that product design characteristics, constituents and additives contribute to the toxicity of cigarettes, the addictiveness of the product and the likelihood that new smokers will start or confirmed smokers will quit. ... Nevertheless, the existing science base is currently not sufficient to allow regulation of these characteristics based on their effects on toxicity of the product either by establishing product performance standards or by prohibiting the use of specific design features or constituents."

3. "Each measured toxicant is treated individually, such that the possibility of chemical interactions -- either enhancing or inhibiting the hazardous properties of the smoke -- is not taken into account."

4. "Further, it is obvious that these calculations have only been possible for those toxicants where index values have been estimated, and not for the rest of the some 4000 individual constituents in cigarette smoke."

5. Even where risk index values are available: "Since many of the potency factors have been derived from animal experiments, the obvious limitations in extrapolating from animal models to the human situation also apply."

6. "These limitations preclude use of these quantitative estimates of the likely harm or risk of exposure to these different toxicants or for comparison of the relative risk or harm of different cigarette brands."

7. Furthermore, the study authors acknowledge that limiting the concentrations of these nine smoke constituents may actually lead to increases in the concentrations of other toxicants: "when only a few toxicants are regulated there is a greater probability that reductions in one toxicant might result in higher level of other toxicants in the brands remaining on the market as an unintended consequence."

8. The authors acknowledge that "it is possible that removal from the market of brands high in levels of the regulated toxicants will leave brands on the market with high levels of those toxicants not regulated. In addition, the changes in cigarette design and manufacturing implemented to lower the regulated toxicants may have the effect of increasing the levels of other non-regulated toxicants."

9. The authors acknowledge that "Existing science does not allow a definitive conclusion that reduction of nitrosamines, or any other individual toxicants in cigarette smoke, will reduce cancer incidence, or the rate of any other tobacco related disease, in smokers who use cigarettes with lower levels of these toxicants...".

10. "Existing science has also not demonstrated that the specified changes in regulatory values will result overall in a meaningful change in actual exposure for consumers...".

11. "Mandating levels and disallowing brands with higher levels from the market is not a statement that the remaining brands are ... less hazardous than the brands removed."

So let's get this straight:

1. There is no evidence that would allow us to conclude that this regulatory approach will result in safer cigarettes.

2. There is no evidence that would allow us to conclude that this regulatory approach will even lower actual exposure to the regulated constituents.

3. There is some evidence to suggest that this approach might even increase the risks of smoking by increasing the levels of non-regulated toxicants.

4. The danger of misleading people about the risks of cigarettes is so grave that we must prohibit any and all public communications from cigarette companies indicating even that they are complying with federal regulations on toxicant levels.

5. Tobacco control scientists are recommending this as a mandatory regulation to be implemented throughout the world.

If one accepts premises #1 through #4 (which we have to, because the authors themselves state and accept these points), then it is absurd to accept point #5.

These researchers are acknowledging that we have no clear idea whether this regulatory approach will make cigarettes safer, keep them the same, or make them more harmful. Yet they conclude that this is a sensible regulatory approach. I just don't get the logic here.

Commentary

Sorry to repeat this point, but it is just too baffling for me to comprehend.

Please help me understand the logic of the following: The World Health Organization's Study Group on Tobacco Product Regulation (TobReg) is proposing that we regulate cigarettes by picking nine constituents and stating that whatever the median level of those constituents currently is in all cigarettes (per mg nicotine) should be the maximum level allowed.

They are recommending this despite their acknowledgment that this approach may well increase the risks of smoking by making cigarettes more hazardous.

This is insanity. I can't think of any other way to describe it.

I have to confess that I no longer can claim to understand what is going on in tobacco control these days. I always thought that it was a science-based movement. But now I find that it is making recommendations that are not based on any science. And it admits that!

That's the thing I just don't get. This article is not trying to hide the fact that there is no scientific justification behind the regulations that are proposed. They readily admit that there is no existing science to support this as a regulatory approach. They readily admit that it could lead to increased toxicity of cigarettes. Yet they recommend it anyway!

I am getting the impression that TobReg wants to regulate cigarettes merely for the sake of regulating cigarettes, not because that regulation will make cigarettes safer. Perhaps it's not their fault. Perhaps when you charge a committee with developing an absurd approach to tobacco control, the resulting proposal they come up with is bound to be absurd.

But couldn't they at least have come back and said: "We've studied the problem, and unfortunately, the existing science base simply does not support regulation of the constituents or emissions of cigarette smoke as an appropriate and effective approach to reducing the harms related to cigarette smoking. At least not at the current time. We will be glad to revisit the issue when and if the science advances to the point that this type of regulation makes some sense."

But no - that's not what they did. Instead, they essentially said: "There is currently no evidence that regulating the constituents or emissions of cigarettes will effectively reduce the harms associated with smoking, and it might even make the problem worse, but we're going to do it anyway."

And what makes this truly tragic is that if this scheme is implemented, it is invariably going to result in the public being misled about the risks of cigarettes on the market. Even if public communications from cigarette companies about the facts of regulation are banned (which is clearly unconstitutional, at least in the United States), the public is still going to find out that cigarettes are being regulated with emissions standards (has anyone ever heard of something called the internet?).

So the public is going to naturally believe that cigarettes have been made safer. Essentially, what this regulatory scheme would do is to transfer the fraud that the cigarette companies have been found guilty of committing (by marketing "light" cigarettes as being safer alternatives) over to the federal government.

It would truly be a dream come true for the tobacco companies. Not only would they be able to reap the benefits of a public that is less concerned about the hazards of smoking, but they wouldn't have to do anything other than comply with federal regulations. The government would be doing all the work for them. And to boot, they wouldn't be liable for any damages caused by misleading the public.

They must be having a field day over at Philip Morris, Reynolds American, and Lorillard today. The insanity of the current tobacco control movement is more than they could ever hope for.

In an editorial published today, the New England Journal of Medicine publicly scolded a Weill Cornell Medical College researcher who failed to disclose to the journal that her research, published in 2006, on the use of CT screening for early detection of lung cancer was funded by Vector, which owns Liggett - a cigarette company.

The Journal wrote: "In October 2006 we published an article by the Lung Cancer Screening Group in which computed tomographic (CT) scanning was used to screen a high-risk population for evidence of early-stage lung cancer. From the data they gathered, the authors concluded that the majority of stage I lung cancers treated after their detection by CT screening had a favorable prognosis. The Lung Cancer Screening Group's research was funded by 32 different entities, one of which was the Foundation for Lung Cancer: Early Detection, Prevention and Treatment. It has not been our practice to inquire about the specific sources of funding of foundations such as this. We recently learned, however, that this foundation was headed by the principal investigator of the 2006 study, that it was housed at her academic institution, and that the only contributor during most of its existence was the Vector Group, the parent company of Liggett, a major tobacco company. We and our readers were surprised to learn that the source of the funding of the charitable foundation was, in fact, a large corporation that could have an interest in the study results. This situation raises two concerns. First, as medical journal editors, we believe that it is important that the ultimate source of funding be made clear to the Journal's readers. Second, it is appropriate to ask whether a study on clinical outcomes in lung cancer should be directly underwritten in part by the tobacco industry. ... We believe that it is important for our readers and the entire biomedical community to be aware of this situation. Our goal is that readers be fully informed about funding sources. It is the responsibility of authors to disclose fully and appropriately the sources of funding of their studies. We expect that authors will be particularly attentive to transparency in reporting if a funding entity has a vested interest in the outcome. The public's trust in biomedical research depends on it."

The Rest of the Story

This editorial accompanied a letter from the researcher in question, who finally (after 18 months) revealed the actual source of the funding she had received to conduct this study.

Hiding this source of funding for 18 months, and failing to disclose it until the New York Times reported the hidden truth, is very poor ethical and scientific conduct.

The Journal makes a great point. Not only does this taint the research itself; it also threatens undermining the public's trust in biomedical research in general.

Wednesday, April 02, 2008

Once again, the Campaign for Tobacco-Free Kids is deceiving the public into believing that the proposed FDA tobacco legislation would require tobacco companies to remove or reduce levels of the components that make cigarettes harmful.

In a press release issued yesterday (April 1), the Campaign for Tobacco-Free Kids claims: "In addition to cracking down on tobacco marketing and sales to kids, the bill would also grant the FDA authority to ban candy-flavored cigarettes; require that tobacco companies disclose the contents of their products and reduce or remove harmful ingredients; stop tobacco companies from misleading the public about the health risks of tobacco products; and require larger, more effective health warnings on tobacco products."

The part of this statement that is not true is the claim that the bill would "require that tobacco companies ... reduce or remove harmful ingredients."

In truth, the bill contains no such requirement. It merely gives the FDA the authority to require the reduction or elimination of certain harmful ingredients. However, the FDA does not have unfettered authority to remove ingredients because it cannot take any action that would have the effect of banning any existing type of tobacco product. Moreover, the tobacco industry is given tremendous influence over FDA's actions: a tobacco industry representative sits on the advisory panel and the legislation contains an escape clause that allows the industry to overturn any regulation simply by obtaining a simple majority vote in Congress (bypassing the usual mechanisms that slow down legislation and make it more difficult to enact).

But the biggest problem with the statement is that it is simply not true.

On the same day that the Campaign for Tobacco-Free Kids is deceiving the public about the FDA tobacco legislation, it is also running an event - Kick Butts Day - that in my view is designed to exploit children for political purposes.

Specifically, Kick Butts Day is in my view set up as an attempt to use youths to promote the FDA tobacco legislation. It is a youth advocacy day which is largely centered around an attempt to try to get youths throughout the nation to advocate for the FDA tobacco legislation.

So far, so good. The problem is that the Campaign is not telling youths the truth about the legislation. It is not informing youths that the legislation is actually supported by Philip Morris, the nation's largest tobacco company. Thus, large numbers of youths are being deceived (tricked, if you will) into supporting the legislation and advocating for it, when in fact, they would not do so if they knew the truth behind it.

This, in my opinion, represents exploitation of children for political purposes. It is unethical and inappropriate for a public health group to engage in this type of exploitation.

The Rest of the Story

The only hope we have of excusing the Campaign for Tobacco-Free Kids is to note that the press release is dated April 1 and to assume that this is merely an April Fools Day prank. Perhaps the Campaign will release a follow-up statement today that says: "April Fools! We were just kidding about the FDA legislation requiring that tobacco companies reduce or eliminate the harmful ingredients in their cigarettes. It was just an April Fools Day prank. We apologize for any confusion that it may have caused."

There is no hope, however, of excusing the Campaign from unethically misusing and exploiting youths to promote its own political agenda. That is plainly inexcusable. While I have no problem with encouraging youths to become engaged in political activity, especially public health advocacy, I believe that it is our ethical obligation to inform those youths about the legislation that they are being asked to support. There needs to be informed consent, if you will. And that means that youths must be informed about the key facts of the legislation. In this case, the most important fact that has been hidden from the youths is the fact that Philip Morris is supporting the legislation that the kids are also being asked to support.

I doubt that a large number of youths would get excited about helping Philip Morris to achieve its legislative aims. And I am quite confident that if the youths found out the truth - that they were being tricked into supporting this legislation by the Campaign for Tobacco-Free Kids - they would be irate.

About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.